Peer Counseling in Family-Based Pediatric Overweight Treatment

描述（由申请人提供）：儿童肥胖在美国非常普遍，以家庭为基础的行为体重控制治疗对年龄较小的超重儿童（6-12岁）已经确立了疗效，治疗后10年体重状况持续改善。美国预防服务工作组最近的建议是，需要中等到高强度的干预措施（25小时接触时间）来帮助超重儿童达到并维持更好的体重控制。然而，大多数健康保险明确禁止超重/肥胖治疗服务或将提供者服务限制在远远低于建议水平（例如，每年最多4次营养检查），这使得治疗方案难以维持。此外，仅在美国就有相当多的超重儿童，大约每3个儿童中就有1个超重儿童，这是专业人士无法治疗的。需要一种以家庭为基础的儿科超重治疗的新模式，既能降低成本，又能维持短期和长期疗效。一种可能的机会是同伴干预模式，在目前的建议中有待开发和初步测试，在这种模式中，接受专业人员提供干预的家庭随后向其他家庭提供干预。该提案还研究了同伴干预者是否通过向他人提供干预来持续参与饮食和体育活动方面的行为改变，从而提高了他们自己的长期疗效。拟议的项目首先采用循证方法，由专业干预学家向超重儿童及其父母（第一代家庭，n=28）提供基于家庭的行为体重控制治疗。接受治疗后，将随机分配一半的第一代家庭作为同伴干预者，对其他超重儿童及其父母（第二代家庭；n=28）进行干预。剩下的第一代家庭既不会接受也不会提供任何额外的治疗。本项目旨在发展同伴干预培训和交付，并在整个干预过程中检查同伴干预交付的可行性和可接受性。本项目还旨在估算同伴干预（接受和提供）对儿童和父母体重结果的影响，并在接受治疗结束和6个月后进行评估。本R21应用程序开发并开始评估以家庭为基础的儿科行为超重治疗的创新交付策略，并有可能在未来进行综合试验，以检查长期体重控制效果、成本效益和推广。

DESCRIPTION (provided by applicant): Childhood obesity is highly prevalent in the U.S. Family-based behavioral weight control treatment for younger overweight children (6-12 years old) has established efficacy, with sustained weight status improvements up to 10 years after treatment. Recent recommendations of the U.S. Preventive Services Task Force are that moderate- to high-intensity interventions (>25 contact hours) are needed to help overweight children achieve and sustain better weight control. However, the majority of health insurance coverage specifically disallows overweight/obesity treatment services or limits provider services far below recommended levels (e.g., up to 4 annual nutrition visits), making it difficult to sustai treatment programs. There are also considerably more overweight children in the U.S. alone, ~1 in 3 children, than professionals could possibly treat. A new model of delivering family-based pediatric overweight treatment that decreases costs, but sustains short- and long-term efficacy, is needed. One possible opportunity, to be developed and initially tested in the current proposal, is a peer intervention model in which families receiving professionally-delivered intervention subsequently provide intervention to other families. The proposal also examines whether peer interventionists' continued engagement in behavior change around eating and physical activity through providing intervention to others improves their own long-term efficacy. The proposed project begins with the evidence-based approach of professional interventionists delivering family-based behavioral weight control treatment to overweight children and their parent(s) (1st generation families; n=28). After receiving treatment, half of 1st generation families will be randomly assigned to serve as peer interventionists to other overweight children and parents (2nd generation families; n=28). The remaining 1st generation families will neither receive nor provide any additional treatment. This project aims to develop peer intervention training and delivery and to examine the feasibility and acceptability of the peer intervention delivery throughout the intervention. This project also aims to derive an estimate of the impact of peer intervention (receiving and providing) on child and parent weight outcomes, with assessments at the end of receiving treatment and 6 months later. This R21 application develops and begins to evaluate an innovative delivery strategy for family-based behavioral pediatric overweight treatment, with the potential for future comprehensive trials to examine longer term weight control efficacy, cost effectiveness, and dissemination.